| NPI | 1356888986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT VAN TIL Owner 616-392-7472 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 213E00000X Podiatrist |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2021-11-24 |